The Best Health Care System in the World

The United States? Bullshit. It’s France. And just because Mitch McConnell thinks that Americans think the best health care in the world is here in the US doesn’t make it so.


I’m a Thinker. . .

Wait. Let me get this straight: in the midst of a debate over how to provide affordable health care to all Americans, is the objection of the majority of Republican politicians that the so called “public option,” might be too affordable?


McCain, Free Markets and Health Care

When dissecting John McCain’s anemic health care “plan,” invariably you find that there are some other topics you’ve missed. But this Boston Herald piece – written in support of his plan – actually does a great job of wrapping up some of the absurdities in a couple of opening paragraphs:

His health-care plan also makes most sense –

The key salvo is aimed at the central pillar of our health care system – tax-subsidized employer-provided health care. About 70 percent of Americans get their health care where they work.

The McCain plan offers a $5,000 tax credit to families and $2,500 to individuals to purchase health care on their own. This would end the inherent inequity of some getting tax-free health care from their employers, but others having to purchase it with after-tax dollars.

Generally, when you fire a “salvo” at a “central pillar,” of a system, your aim is not to improve said system. And indeed, this plan does not improve the situation one bit. But remarkably Freudian semantics aside, let’s deal with the plan. And while we’re focusing on John McCain’s plan, let’s set aside the zero-sum game of trading “subsidies” for “tax credits,” which are effectively the same thing. Let’s also ignore the fact that $5000 isn’t going to get you the same level of health care you had under your employer’s plan, even if you work at Sutherland.

Rather, I’d like to discuss the obvious misapprehension many Conservatives seem to have about the health insurance industry and the “free market.”

In a Utopian “free market” system, I get a paycheck every week which I then use to buy goods and services at will. I go to my local store and negotiate directly with the owner of the quaint little shop, Mr. Walmart, to get the best deal. No government has any role in the transaction, it’s just mano-a-mano consumer spending, and then we all go down to the fishin’ hole, whistling a happy tune, and catch us a mess of catfish.

However in the current system – and indeed the system John McCain would like to perpetuate – we don’t deal directly with the shopkeeper, the doctor and the hospital, at all. We buy a service from an insurance company and then expect that service to do it’s job when the time is right.

It probably goes without saying that this website is not the most outspoken champion of free market economics in Rochester, but any fool can see that the insurance industry mutates the supposed free market transaction at least as much as any government. There is an expectation of service on the consumer’s part – as the article points out quite correctly, without asking how much it costs – which compels insurance companies to spend without restriction on some things. Hence there is no particular free market control over the price of medicine, medical equipment or services at a hospital. Meanwhile, to control cost and maximize profit, insurance companies have begun saying “no” to many procedures and knocking people off the roles.

Basically, you’ve got giant pharmaceutical companies fed unlimited resources by giant health insurance companies and somewhere in the middle of all that, barely factored into the decision making, are you and your doctor. But the Conservatives want you to believe that you and your doctor are the most important people in the equation.

I know I’ll get a lot of heat from Conservative circles, but if you don’t plan to outlaw health insurance outright, I’ll take programs led by a democratically elected government over those created to maximize profits of everybody in the world but me any day of the week.


Healthy New York? Really?

I have a friend who just lost his job and is in need of medical insurance because of existing conditions.  He was checking into Healthy New York and discovered something that should raise more than a few eyebrows out there: HealthyNY does not cover mental health.  At all.

So, after all those television commercials featuring our former governor Pataki, where does one go to get mental health issues covered if they’re out of work?  Even better, our supposed lifeline for health insurance in this country also goes on in its website to state the following:

Pre-Existing Condition Limitation

Coverage under the Healthy NY program is subject to a pre-existing condition waiting period. This means that if the applicant has a medical condition that they have been either diagnosed with or treated for in the last six months, services for the treatment of that condition may be excluded from coverage for up to a year.

Republicans and Conservatives can say what they want about the government not getting involved in people’s lives.  But I think a big question we all have to ask ourselves is: if they’re going to get involved, what are we going to get for our tax dollars?

More coverage to come. . .


Benefits Denied

NOW has an interesting article up about freelancers/temporary workers/contractors and the role they (eh-hem, we) play in our current economy.  I have long believed that the rise of the service economy has been used by Corporate America to break down the relationship between workers and the benefits that unions have worked so long and so hard to give us.

Things like holidays and weekends become “floating holidays” and a couple of arbitrarily arranged days off during a week in the face of the “24/7 Help Desk.”  Benefits become something you get at “good jobs” and don’t expect to be able to pay for at your current job.  And those “floating holidays” always seem to float away before you’ve used them, over the “use them or lose them” horizon for another year.

Many of us who work as non-staff employees like or even love our jobs.  For those in IT or other “knowledge industry” professions, working contract jobs is a matter of course, anyway.  Like the woman in the NOW piece, we have nothing personal against our employers.   But we are perfectly capable of becoming sick somewhere during our time at our jobs, and when that happens, who will pay for the health care we need?  How can we maintain our health if we cannot get days off like normal people?  I only barely was able to get a mortgage because of my status as a contractor, even though my status is no less stable than your average manufacturing worker and perhaps more so.

This is of course one more argument for universal coverage.  In other countries, such as Holland, most people work in as informal arrangements as us temps here in the states.  The difference is that their government provides the benefits instead of the employer.  With this one rather imperative duty lifted from both workers and employers, the system works much better and allows both parties more freedom.

Such an arrangement here would do incredible things for all of us, but especially small businesses and start ups.  Imagine not having to worry about providing benefits for your family, only concentrating on working at the best gig you can find and doing your best work.


“Gaming” the Universal Health Care System

Dean Baker has an interesting discussion of the differences between the health care plans of Barack Obama and Hillary Clinton. While ultimately, I think that either plan will necessarily undergo huge changes before it reaches any as yet unproduced bill, it is interesting from a nuts-and-bolts perspective to see what the real effects of each plan might be:

Beat the Press Archive | The American Prospect

Actually, even a mandate will not get to universal coverage, as Leonhardt notes. The purpose of the mandate is to prevent gaming of the system. If everyone has the option to buy into the system whenever they want, and to pay the same price regardless of any pre-existing conditions (a part of both candidates’ programs), then healthy people have no incentive to buy insurance. They can pay minor expenses out of pocket and hold off buying insurance until a point where they actually do have major medical expenses.

I don’t see this as a particularly huge concern in the first place, to be honest. I think most people would recognize that, even if you can wait a few more years before the Parkinson’s really kicks in, no such timeline exists for your next motorcycle accident. What might happen is that people stick with their current employer-provided health care systems until they realize those systems cannot pay for what they need and then swap over to the national system. THAT could be a real problem.

And beyond that, we need to begin to realize that we are all responsible for and we all pay for the health and wellbeing of our neighbors. This isn’t some fluffy-white-clouds Liberal ideal, but a very practical reality of our health care system. Universal Health Care is not an entitlement system, it is a nation-wide infrastructure in the exact same way roads and bridges are. In the exact same way that broadband and wireless Internet access aught to be considered, but that’s another story.

We don’t discriminate between who can and who cannot use the roads based on income, and all of us pay for the upkeep and maintenance of those roads. You don’t need to imagine what the costs might be if only those who can afford to pay for roads got to use them, you only need to walk into the emergency room.


Universal Coverage, an Insurer’s Version

Via the American Prospect’s Dean Baker, the New York Times does an outstanding job of shining up an Insurance industry turd and making it look like solid gold. You would think that, with a title like “Insurers Seek Bigger Reach in Coverage,” this would be a story about insurers really making an effort to make sure everybody got covered under their plans. Ha! You would if you were a sap.

Instead, the plan is: let those who can afford the good stuff pay for private insurance, and let the po folk and the sick folk go beg the gubbamint for their lives:

Insurers Seek Bigger Reach in Coverage – New York Times

The proposals, approved by a board of the industry’s main trade group, would make it harder for insurers to cancel policies or deny coverage to people with pre-existing medical conditions. The steps would also limit the premiums that could be charged for such people. The trade group also called on states to provide individual coverage for people who were likely to incur very high medical bills.

About the only bright spot in this discussion is the fact that this points out a certain inevitability factor for universal health care. Big Insurance has figured out the game, and like all good business men, is seeking to lose on their own terms, which is the same as winning.

The Republican Welfare State

I was watching the Sunday news programs yesterday, and on This Week, both David Brooks and George Will used the term “Middle-Class Entitlement Programs” to describe the problems with our budget. What they were referring to is the SCHIP program, with it’s ability to reach kids whose parents make as much as $80,000 a year. Both conceded that Bush’s threat to veto the bill was tantamount to shooting oneself in the foot, but they both insisted that such programs (and without naming them directly, they were referring to Social Security and Medicare, also) were ruining our nation’s balance sheets unnecessarily. Because, of course, the middle class can handle it on their own.

This is the classic case of the Republican Welfare State, a self-fulfilling prophesy and a recursive logical argument which is their party’s platform.

Health Care, CNN Debates, and Blending Hot-Button Issues

More commentary on the YouTube/CNN debates of the other night.

Now we move on to the health care industry. But the YouTube user who asks this question decided to get cheeky with it. This question blends two hot-button issues into one question, “would you plan cover undocumented workers.”

But the only real answer to this question points out an important concept of universal coverage which deserves more discussion, which I will add below the fold ->